Attachment_5_Forms_to_Submit_with_Quote.docx

1. 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (NOV 2021) The Offeror shall not complete the representation at paragraph (d)(1) of this provision if the Offeror has represented that it "does not provide covered telecommunications equipment or services as a part of its offered products or services to the Government in the performance of any contract, subcontract, or other contractual instrument" in paragraph (c)(1) in the provision at 52.204-26, Covered Telecommunications Equipment or Services—Representation, or in paragraph (v)(2)(i) of the provision at 52.212-3, Offeror Representations and Certifications-Commercial Products or Commercial Services. The Offeror shall not complete the representation in paragraph (d)(2) of this provision if the Offeror has represented that it "does not use covered telecommunications equipment or services, or any equipment, system, or service that uses covered telecommunications equipment or services" in paragraph (c)(2) of the provision at 52.204-26, or in paragraph (v)(2)(ii) of the provision at 52.212-3.

(a) Definitions. As used in this provision— Backhaul, covered telecommunications equipment or services, critical technology, interconnection arrangements, reasonable inquiry, roaming, and substantial or essential component have the meanings provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(b) Prohibition.

(c) Procedures. The Offeror shall review the list of excluded parties in the System for Award Management (SAM) ( https://www.sam.gov) for entities excluded from receiving federal awards for "covered telecommunications equipment or services".

(d) Representation. The Offeror represents that—

(e) Disclosures.

Relevant Experience The purpose of this form is for the offeror to list construction projects (preferably performed during the past five (5) years) that are similar to the work described in this solicitation. The number of projects listed shall not exceed three (3) and shall be numbered consecutively, beginning with the most recent project. Use this form to address your familiarity with the Scope of Work described in the plans and specifications and with the capability criteria described in the Request for Proposal. Include area codes with all telephone numbers. Type or print legibly.

The Government may contact the entities listed herein to obtain past performance reviews of the offeror’s team. Past performance is a measure of the degree to which the Offeror satisfied its customers in the past and complied with federal, state, and local laws and regulations. The past performance of the offeror, key personnel (if applicable), and proposed subcontractors on projects similar in scope and complexity (i.e. relevant to the current project) will be evaluated in the areas of quality, timeliness, and business relations. It is especially important that the offeror disclose instances in which their past performance may be considered by others to be less than fully satisfactory. The offeror should tell their side of the story and describe remedial corrective action that has been taken or will be taken to correct the deficiency. Failure to do so may result in a determination that an offeror has been less than candid with the Government, which could result in an unfavorable assessment of the offeror’s past performance record.

NAME OF CONTRACTOR/QUOTER:

PROJECT NAME:

Project Location:

Name of Owner:

Address of Owner:

Telephone Number:

Project Value:

Dates of Service/ Supply:

DESCRIPTION OF THE PROJECT AND SCOPE OF QUOTER’S WORK

DESCRIPTION OF THE PROJECT AND SCOPE OF QUOTER’S WORK:

PERFORMANCE REMARKS (Leave blank: to be filled out by NPS evaluator)

List of proposed subcontractors The purpose of this form is for the Quoter to list the proposed subcontractors who will perform on the contract. Include a brief description of the work they will perform. Fill in the information by typing or printing legibly.

NAME OF CONTRACTOR/VENDOR/QUOTER: _______________________________

SUBCONTRACTOR NAME:

UEI:

Small Business

Yes

No

Address and website/email address:

DESCRIPTION OF PROPOSED SUBCONTRACTOR WORK:

SUBCONTRACTOR NAME:

UEI:

Small Business

Yes

No

Address and website/email address:

DESCRIPTION OF PROPOSED SUBCONTRACTOR WORK:

SUBCONTRACTOR NAME:

UEI:

Small Business

Yes

No

Address and website/email address:

DESCRIPTION OF PROPOSED SUBCONTRACTOR WORK:

SUBCONTRACTOR NAME:

UEI:

Small Business

Yes

No

Address and website/email address:

DESCRIPTION OF PROPOSED SUBCONTRACTOR WORK:

Subcontractor Reference/Experience

READ CAREFULLY: The purpose of this form is for the quoter to provide references for key subcontractors who are considered critical to the successful accomplishment of the project. Use as many sheets as necessary. These subcontractor references should include additional relevant projects similar to the work described in the scope of work (SOW). Include area codes with all telephone numbers and email addresses. Fill in the information by typing or printing legibly.

SUBCONTRACTOR (PROPOSED):

ADDRESS:

TELEPHONE NUMBER:

PROJECT NAME:

Name of Owner:

Location:

Prime Contractor:

Telephone Number:

Email Address:

Subcontract $ Value:

Dates of Performance:

Customer/Reference Name, telephone and email address

DESCRIPTION & DETAILS OF WORK

SPECIFIC AREAS OF EXPERIENCE (SEE QUOTE INSTRUCTIONS CONTENTS FOR THE SUBMISSION OF QUOTES AND OTHER INFORMATION)